Coronavirus Form - San Antonio Report

Have you or someone you know tried to get tested or been tested? *

If this is someone you know, is it someone related to you? *

Please specify your relationship with the person *

Please use self if you are relaying a personal experience

If the person tested was not you, do you have permission to share their story? *

Please share the experience in as much detail as possible: *

Name *

First

Last

Where do you live? If outside of Texas, please include your state or country *

Email *

Please enter a valid email address

Phone

What is the best way to contact you? *

Note: By submitting this information, you are agreeing to our terms of service.

Phone